Introduction. This paper is based on the third Edition of the RNAO “Pain Assessment and Management” guideline applied to total hip arthroplasty (THA) patients and the evaluation of clinical practice guidelines on pain management and patient satisfaction. Objective: To apply the Third Edition Guideline for the Pain Assessment and Management from RNAO to patients after total hip arthroplasty and evaluate its effectiveness. Division of topics covered. Evaluate the knowledge, assessment of pain by nursing, and satisfaction in the care of patients with total hip arthroplasty before and after the implementation of the guide, according to the Knowledge to Action Framework. According to 20 recommendations from the Guideline, 6 quality review indicators were formulated: 1. Establish and implement standard assessment processes and forms; 2. Conduct nurse training and patient education; 3. Compare nurses’ pain knowledge and attitude levels before and after evidence-based practice; 4. Compare nurses’ implementation of various indicators of patient pain assessment and management; 5. Compare pain control satisfaction of total hip arthroplasty patients before and after Best Practice Guideline implementation; and 6. Ensure nurses use the same proven tool to assess pain in patients. Results. After implementing the Guideline, the rate of nurses’ knowledge of pain assessment and management has increased from 42.6% to 48%. Nurses’ pain screening and evaluation, strategies to encourage patients and if the families participated in pain management were recorded after an assessment, and they were statistically significant (all P<0.05). There were statistically significant differences in patients’ perceptions of pain management, active reporting of pain, and patient satisfaction with pain control (all P<0.05). Conclusion: The application of the evidence can improve nurses’ knowledge and attitude toward pain assessment and management, standardize their operating system and process, and improve patients’ satisfaction with pain control. Keywords: Arthroplasty, Replacement, Hip; Pain; Evidence-Based Practice; Practice Guideline Introducción. Este artículo se basa en la tercera edición de la guía de “Evaluación y Manejo del Dolor” de la RNAO, aplicada a pacientes con artroplastia total de cadera (ATC) y en la evaluación de guías de práctica clínica sobre el manejo del dolor y la satisfacción del paciente. Objetivo: Aplicar la tercera edición de la Guía de Evaluación y Manejo del Dolor de la RNAO a pacientes después de la artroplastia total de cadera y evaluar su efectividad. División de temas tratados. Evaluar el conocimiento, la valoración del dolor por parte del personal de enfermería y la satisfacción de los pacientes con artroplastia total de cadera antes y después de la implementación de la guía, siguiendo el Marco de Conocimiento para la Acción. Con base en las 20 recomendaciones de la Guía, se formularon 6 indicadores de calidad para su revisión: 1. Establecer e implementar procesos y formularios estandarizados de evaluación; 2. Realizar capacitación de personal de enfermería y educación a los pacientes; 3. Comparar los niveles de conocimiento y actitudes del personal de enfermería sobre el dolor antes y después de la práctica basada en evidencia; 4. Comparar la implementación de varios indicadores de evaluación y manejo del dolor en los pacientes por parte del personal de enfermería; 5. Comparar la satisfacción de los pacientes con artroplastia total de cadera respecto al control del dolor, antes y después de la implementación de la Guía de Buenas Prácticas; 6. Asegurar que el personal de enfermería emplee la misma herramienta acreditada para evaluar el dolor en los pacientes. Resultados. Tras la implementación de la Guía, la tasa de conocimiento del personal de enfermería sobre la evaluación y manejo del dolor aumentó del 42.6% al 48%. La evaluación del dolor por parte del personal de enfermería, las estrategias para motivar a los pacientes, y si las familias participaban en el manejo del dolor, fueron evaluadas y se registraron con diferencias estadísticamente significativas (todos P < 0.05). También, se presentaron diferencias estadísticamente significativas en las percepciones de los pacientes sobre el manejo del dolor, el reporte activo del dolor y la satisfacción de los pacientes con el control del dolor (todos P < 0.05). Conclusión. La aplicación de la evidencia puede mejorar el conocimiento y la actitud del personal de enfermería hacia la evaluación y manejo del dolor, estandarizar sus sistemas y procesos operativos, y mejorar la satisfacción de los pacientes sobre el control del dolor. Palabras clave: Artroplastia de Reemplazo de Cadera; Artroplastia; Artroplastia de Reemplazo; Cadera; Dolor; Práctica Clínica Basada en la Evidencia; Guía de Práctica Clínica Introdução. Este artigo baseia-se na terceira edição do guia “Avaliação e Manejo da Dor” da RNAO, aplicada a pacientes com artroplastia total de quadril (ATQ) e na avaliação de guias de prática clínica sobre manejo da dor e satisfação do paciente. Objetivo: Aplicar a terceira edição do Guia de Avaliação e Manejo da Dor da RNAO em pacientes após artroplastia total de quadril e avaliar sua eficácia. Divisão dos tópicos abordados. Avaliar o conhecimento, a avaliação da dor pela equipe de enfermagem e a satisfação dos pacientes com artroplastia total do quadril antes e após a implementação do guia, seguindo a Estrutura de Conhecimento para Ação. Com base nas 20 recomendações do Guia, foram formulados 6 indicadores de qualidade para revisão: 1. Estabelecer e implementar processos e formulários de avaliação padronizados; 2. Realizar treinamento da equipe de enfermagem e educação dos pacientes; 3. Comparar os níveis de conhecimento e atitudes da equipe de enfermagem sobre a dor antes e depois da prática baseada em evidências; 4. Comparar a implementação de diversos indicadores de avaliação e manejo da dor em pacientes pela equipe de enfermagem; 5. Comparar a satisfação dos pacientes com artroplastia total do quadril quanto ao controle da dor, antes e após a implementação do Guia de Boas Práticas; 6. Garantir que a equipe de enfermagem utilize a mesma ferramenta credenciada para avaliar a dor nos pacientes. Resultados. Após a implementação do Guia, o índice de conhecimento da equipe de enfermagem sobre avaliação e manejo da dor aumentou de 42.6% para 48%. A avaliação da dor pela equipe de enfermagem, as estratégias para motivar os pacientes e o envolvimento das famílias no manejo da dor foram avaliadas e registradas com diferenças estatisticamente significativas (todos P < 0.05). Além disso, houve diferenças estatisticamente significativas nas percepções dos pacientes sobre o controle da dor, no relato ativo da dor e na satisfação dos pacientes com o controle da dor (todos P < 0.05). Conclusão. A aplicação de evidências pode melhorar o conhecimento e a atitude da equipe de enfermagem em relação à avaliação e manejo da dor, padronizar seus sistemas e processos operacionais e melhorar a satisfação do paciente em relação ao controle da dor. Palavras-chave: Artroplastia de Quadril; Artroplastia; Artroplastia de Substituição; Quadril; Dor; Prática Clínica Baseada em Evidências; Guia de Prática Clínica

目的 比较门诊康复与家庭康复对膝关节置换术后膝关节功能恢复的效果.方法 计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Embase、Cochrane Library、Web of Science,纳入有关膝关节置换术术后门诊康复与家庭康复比较的随机对照试验(randomized controlled trial,RCT).检索时限为建库至2021年7月.由2名研究者对所得文献依据纳入与排除标准进行筛查,提取资料,评价文献质量,采用RevMan 5.3软件进行Meta分析.结果 共纳入15项RCT研究,共2492例患者.Meta分析结果显示,膝关节置换术后1～1.5、3、6、12个月时,门诊康复与家庭康复后患者的关节活动范围、骨关节炎指数评分、膝关节损伤和骨关节炎结局评分、牛津大学膝关节评分、膝关节功能评分等结果变化的差异均无统计学意义(P>0.05),且两组在不良反应、生活质量和满意度方面的差异均无统计学意义(P>0.05),但家庭康复组所支付的医疗费用较低.结论 膝关节置换术术后1年内家庭康复与门诊康复能取得相似的康复效果,且安全性良好,另外,家庭康复可降低医疗费用.

骨科术后患者的疼痛问题已被广泛关注,除了药物等的治疗外,在临床上加强心理护理可以缓解疼痛,现在分析了解心理暗示疗法对骨科患者术后疼痛的影响及心理暗示的方法,探讨多种影响因素,并对心理暗示疗法改善骨科患者术后疼痛的研究进展进行论述.

Objective Objective To explore the status and influencing factors of acute pain control in patients after total knee arthroplasty under multimode analgesia, and to provide basis for pain management. Methods From June 2017 to June 2018, the patients who were diagnosed with knee osteoarthritis in the department of orthopedics of the Lanzhou University Second Hospital and who were to undergo total knee arthroplasty, age 40~80 years and with clear consciousness, were selected by handy sampling method. A total of 200 patients were included after excluding patients with pain caused by other diseases and severe heart, liver and kidney diseases. General information questionnaire was used 24 h before surgery; 24 h, 48 h and 72 h after surgery, pain scale was used to measure the degree of pain. The Houston pain scale was used to investigate the postoperative acute pain control 72 h after surgery. Pain control status, pain degree, age, body mass index(BMI), numbers of years of pain, analgesics, duration of analgesics, knee function score and preoperative psychological data were described by(±s), and t test was used for comparison between the two groups; gender, education level, labor intensity, previous pain history, cartilage injury degree were expressed as percentage, and chi-square test was used for comparison between the two groups. Results All the patients hoped to control the postoperative pain within the mild range. The mean pain score 72h after the surgery was (3.2±0.8), and the patient still had moderate pain in the acute phase. Subjects were less satisfied with pain control education. The patients had acute pain were significantly older in age(t=7.392, P<0.05), had larger BMI(t=6.214, P<0.05), longer duration of analgesic use(t=7.392, P<0.05), higher intensity of preoperative pain(t=1.321, P<0.05), higher degree of cartilage injury(χ2=0.519, P<0.05), more remarkable pain belief and perception(t=2.121, P<0.05) and catastrophic pain (t=1.103, P<0.05). Logistic regression showed that BMI, pain intensity during preoperative activities, degree of cartilage injury and pain disaster could significantly affect the control of postoperative acute pain. Conclusion The acute pain following TKA can be relieved obviously under multimode analgesia. BMI, pain intensity during preoperative activities, degree of cartilage damage and pain catastrophic can significantly affect the control of postoperative acute pain. Key words: Arthroplasty, replacement, knee; Acute pain; Risk factors

Objective To investigate the effects of different bladder exercises on urinary retention after total knee arthroplasty. Methods A total of 120 patients with urinary retention who underwent total knee arthroplasty in our department from January 2017 to January 2018 were enrolled in the study. They were randomly divided into three groups.On the basis of conventional total knee arthroplasty, 40 patients in the experimental group underwent abdominal muscle, pelvic floor muscle, bladder muscle exercise combined with bladder therapy instrument rehabilitation therapy, and 39 patients in control groupⅠunderwent individualized open urinary bladder passive bladder training. 41 patients in group Ⅱ underwent regular open urinary bladder passive bladder training, and observed the patient's first time of urinary urination, bladder residual urine volume and urination on the third day after surgery. Results The first self-diarrhea time of the experimental group, the control groupⅠand the control group Ⅱ were (129.6±40.2), (177.6±55.8), (224.4±72.6) min, respectively. The residual urine volume on the third day after operation was: (68.21 ±6.49), (87.95±7.28), (92.47±6.65) mL; the effective rate of urination was 97.50％, 87.18％, 78.05％; the difference between the experimental group and the control groupⅠand the control group Ⅱ (P＜0.05). Conclusion Abdominal muscle, pelvic floor muscle, bladder muscle exercise combined with bladder treatment instrument can effectively alleviate the symptoms of urinary retention after total knee arthroplasty, which is worthy of popularization in clinical practice.

目的 探讨促进术后恢复(Enhanced recovery after surgery,ERAS)在髋膝关节置换围手术期的护理应用效果.方法 选取2016年3月~2017年3月在我院行髋膝关节置换术治疗及围手术期护理的100例患者,采用随机数字表法将其分为对照组(未应用ERAS)及观察组(应用ERAS),各50例.对两组患者护理效果进行比较.结果 观察组并发症发生率为6%,对照组并发症发生率为16%,差异有统计学意义(P<0.05);两组围手术期指标相比较,差异有统计学意义(P<0.05).结论 在髋膝关节置换围手术期护理中应用ERAS可明显降低并发症发生率,促进患者康复,值得推广使用.